Printed from https://www.whatdotheyknow.com/request/family_and_carer_involvement_in?utm_campaign=alaveteli-experiments-87&utm_content=sidebar_similar_requests&utm_medium=link&utm_source=whatdotheyknow on June 07, 2020 09:27

- In 2004 NICE recommended approach for mental health in CG1 stated the value and importance of involving family or Carers in the care of persons experiencing mental illness. The theme was reiterated even strengthened in successive CG issues.

- In the same year 2004 RCPsych issued a series of checklists recommended to be used by psychiatrists, to assist them in best practice, and to aid implementation of a ‘family’ approach.

- Since before year 2000, BSMHFT (then under different name) has financially supported, incorporated and promoted the work of the Meriden Family Programme in Birmingham. Key aims of MFP were to develop, train for, and thus implement Family Involvement within the Trust and wider fields wherever their expertise was appreciated. Awards: I see that a national award was gained in 2004 by MFP, for their insight and value to M/H approach up to that date (source BSMHFT/MFP web site).

I have 4 questions:

(1) Please can you tell me when the Trust first implemented their policy of involving family or Carers as an important benefit in the management of mental illness?

(2) What is the Trust policy on M/H Act Assessment team makeup? (e.g. 2 minimum; 3 recommended; other attendees )?

(3) Please can you tell me when the Trust implemented a policy of supplementing M/H assessment teams with concurrent attendance of e.g. 'Home Treatment' team?

Thank you for your request for information. Your request was received on 09/02/2018 and I am dealing with it under the terms of the Freedom of Information Act 2000.

You will receive the information requested within 20 working days unless the Trust does not hold the information or there is a reason for it to be withheld. I will write to you in any event.

Accessibility requirements: If you have any requirements regarding the format any information should be supplied in, e.g. the language to be used, audio, large print, verbal explanation and so on, then please let me know.

If you have any queries or concerns then please do not hesitate to contact me. Please remember to quote the reference number above in any future communications.

Further information about your rights is also available from the Information Commissioner at: Information Commissioner's Office Wycliffe House Water Lane Wilmslow Cheshire SK9 5AF Telephone: 08456 30 60 60 or 01625 54 57 45 or www.ico.gov.uk

Thank you for your request. The Trust would like you to clarify the following so that we continue to process your FOI request.

Question 1 - please clarify if you are referring to a policy specifically around carers/families which has been ratified by the Trust Board?
Question 3 - please clarify in you are referring to the mental health act assessment teams when you mention 'M/H assessment teams'? Can you please clarify what specific information you require in regards to this query.

Can you also clarify the time frames for the questions i.e. how far back do you require this documentation?

Once we have received clarification the Trust will continue to process your FOI request.

Question 1 - please clarify if you are referring to a policy specifically around carers/families which has been ratified by the Trust Board?
A: I confess I do not know what your understanding or definition of Policy is, in this respect. If it is open to interpretation by your employees or service users or affected carers it should not be, in my view. Essentially I refer to any Policy that would be understood and described as such by your workforce. You may feel you have to give clarifying answers to this question if there is likely to be an element of question or interpretation.

Question 3 - please clarify if you are referring to the mental health act assessment teams when you mention 'M/H assessment teams'?
A: Yes that is what I was referring to; assessments carried out under m/h Act and either with or without subject's consent or understanding (immediate or short term e.g. due to subject's cognitive state).

Q: Can you please clarify what specific information you require in regards to this query.
A: My questions 2 and particularly 3 refer to this in consideration of national and professional guidance, OR local initiatives. Do you have any information as to when policies were introduced, terminated or strengthened regarding these?

Q: Can you also clarify the time frames for the questions i.e. how far back do you require this documentation?
A: Existing policies in 2003 and changes in policy since (of the type requested) - if any.

" By law, public authorities must respond “promptly” to requests. We interpret this to mean that you should expect a response as soon as is practical for the authority in question, taking into consideration factors such as the quantity of information you have requested, the authority’s workload from other requests, and the staff available to deal with them. In any case, the law states that they must respond within 20 working days"

Thank you for your email received today. The Trust is continuing to process your FOI request.
As the Trust sought clarification on this request and received your clarification on 13/03/2018, the Trust's deadline for responding to this request is 13/03/2018 but we will endeavour to reply promptly and if possible prior to this deadline once all of the information has been collated.

Thank you for your request for information received on the : 09/02/2018

We have considered your request and can provide the following information
in the document attached.

If you are unhappy with the service you have received in relation to your
request and wish to request a review of our decision, you should write to
the Freedom of Information Officer, BSMHFT, 50 Summer Hill Road,
Birmingham, B1 3RB, or e-mail [1][email address]

If you are not content with the outcome of your review, you may apply
directly to the Information Commissioner for a decision. Generally, the
ICO cannot make a decision unless you have exhausted the complaints
procedure provided by our trust. The Information Commissioner can be
contacted at:

Please excuse my requesting clarification but I wondered if you focussed on answering in context of dates. I’m not sure the material you gave is relevant to my questions unless there has been no change since that time. I asked for information in context of 2004 forwards. For instance the Act was in force but interpretation may have altered.

Also I asked for information relevant to national and local policies at the time, in the first instance. As a lay person I can not tell what national procedures you implemented and what local procedures you implemented as Trust policy - and by Policy I allude to some mandatory or obligatory instruction, Trust-wide..

You have provided later material based on the Act of 1983, but modified in interpretation as at 2015. The documents you have shown me are a bit heavy but are specific in key areas; yet I know that they are followed to various degrees even up to the present date, and have been open to different interpretations by different practitioners hence my questions.

You may not be aware of local procedures not specifically in the Act (1983) which you have endorsed as basic policy. For instance you strongly promote involvement of carers as a prime feature of approach as introduced by Meriden Family Programme from around 1998. I gave two examples of national policies from 2004. Do not leave me to assume no change in BSMHT practice since 1983 through all intervening guidance or BSMHT funded effort. When did BSMHT react to those national policies please?

Returning to my questions:

(1) You said “the Trust did not have a specific policy for involving family and carers…” This appears to be a very odd response. You refer to “other’ policies” which were not specified (local or national). I’m confused: so when were these other policies first implemented, if at all?

(2) I thought the answer was a bit vague: you left me to interpret the Mental Health Act Code of Practice and to what degree a ‘code’ is followed. You added “others may be involved dependent upon circumstances [including e.g.] interpreters; [specialists]; students; advocates.

(3) In this I was specific. Your answer was as per Q2 but you left out my specific case which was none of those. So, on a different tack, to help you out,

(i) would the ‘minimum team’ (2, or 3 preferably according to situation) need to obtain the patient’s permission to expand the attendance team, in consideration of his or her present condition or ‘capacity’, as would be expected, say, with a GP’s appointment? And

(ii) What particular value would a 'Home Treatment' team in an actual mental health assessment under the Act., and where is this referenced in BSMHT policy?

(4) You said, essentially, that you could not search documents substantiating practice relevant to the time in question. So perhaps these are kept or are accessible online or elsewhere, centrally?

All questions: I believe it is part of recommended remit in FOI terms to try and help the questioner obtain understandable answers to questions by giving a clearer picture of what you do generally or, in my case, what you did 2003-2010. Are you able to give me the gist of instructions/policies which would be ‘too expensive’ to examine. You may do this for example by asking Clinical Lead; Family Care Lead; Meriden Programme; Nursing Lead; etc. who may produce past policy?

Please will you clarify the points raised? I would rather not leave this topic feeling that your answers were correctly handles, accurate and not in any way ‘evasive’. These responses are visible publicly on the WhatDoTheyKnow website.

Please will you clarify the points raised? I would rather not leave this topic feeling that your answers were not correctly handled, not accurate or in some way ‘evasive’. These responses are visible publicly on the WhatDoTheyKnow website.

Please excuse my requesting clarification but I wondered if you focussed on answering in context of dates. I’m not sure the material you gave is relevant to my questions unless there has been no change since that time. I asked for information in context of 2004 forwards. For instance the Act was in force but interpretation may have altered.

Also I asked for information relevant to national and local policies at the time, in the first instance. As a lay person I can not tell what national procedures you implemented and what local procedures you implemented as Trust policy - and by Policy I allude to some mandatory or obligatory instruction, Trust-wide..

You have provided later material based on the Act of 1983, but modified in interpretation as at 2015. The documents you have shown me are a bit heavy but are specific in key areas; yet I know that they are followed to various degrees even up to the present date, and have been open to different interpretations by different practitioners hence my questions.

You may not be aware of local procedures not specifically in the Act (1983) which you have endorsed as basic policy. For instance you strongly promote involvement of carers as a prime feature of approach as introduced by Meriden Family Programme from around 1998. I gave two examples of national policies from 2004. Do not leave me to assume no change in BSMHT practice since 1983 through all intervening guidance or BSMHT funded effort. When did BSMHT react to those national policies please?

Returning to my questions:

(1) You said “the Trust did not have a specific policy for involving family and carers…” This appears to be a very odd response. You refer to “other’ policies” which were not specified (local or national). I’m confused: so when were these other policies first implemented, if at all?

Trust Response
The Trust does not have a policy specifically in relation to family and carers. To clarify the policies mentioned are local (Trust) policies. The Trust has 151 policies many of which are likely to contain references to carers and families in which there would need to be an inspection of each policy to check whether they refer to carers and families. Is there is a specific aspect of families and carers involvement that you require information? (A few policies I might mention is the care planning approach policy and Duty of Candour policy but there are many other policies that are likely to refer to carers and families).

(2) I thought the answer was a bit vague: you left me to interpret the Mental Health Act Code of Practice and to what degree a ‘code’ is followed. You added “others may be involved dependent upon circumstances [including e.g.] interpreters; [specialists]; students; advocates.

Trust Response
As per our response to FOI458 the Trust undertakes Mental Health Act assessments as prescribed by the Mental Health Act and the code of practice. Alongside this the Trust (local) policy on Joint Assessments (which was included in our response) provides guidance for staff in undertaking Mental Health Act assessments, which was also in response to this question. Please confirm if there is anything else you wish clarified in addition to the answers provided in our response.

(3) In this I was specific. Your answer was as per Q2 but you left out my specific case which was none of those. So, on a different tack, to help you out,

(i) would the ‘minimum team’ (2, or 3 preferably according to situation) need to obtain the patient’s permission to expand the attendance team, in consideration of his or her present condition or ‘capacity’, as would be expected, say, with a GP’s appointment? And

(ii) What particular value would a 'Home Treatment' team in an actual mental health assessment under the Act., and where is this referenced in BSMHT policy?

Trust Response

(i) In regards to capacity this is an additional question from the original request - please confirm if you wish the Trust to consider this as a new request in regards to capacity and obtaining patient's permission?

(ii) Mental Health Act assessments are undertaken alongside the policy guidelines outlined in the Joint assessment policy (which was included in our response). Page 8-9 of the policy sets out guidance in regards to Home Treatment Teams.

FOI provides documented evidence and is not able to comment on circumstances or situations as these decisions would be undertaken by the team involved at the time of the assessment dependent upon the situation.

(4) You said, essentially, that you could not search documents substantiating practice relevant to the time in question. So perhaps these are kept or are accessible online or elsewhere, centrally?

Trust Response
For this response we applied Section 12 as it would exceed the cost and time limits to locate all of the documents back to 2003-4 in relation to families and carers. These documents are not held centrally. If there is specific information that you require please do let us know.

All questions: I believe it is part of recommended remit in FOI terms to try and help the questioner obtain understandable answers to questions by giving a clearer picture of what you do generally or, in my case, what you did 2003-2010. Are you able to give me the gist of instructions/policies which would be ‘too expensive’ to examine. You may do this for example by asking Clinical Lead; Family Care Lead; Meriden Programme; Nursing Lead; etc. who may produce past policy?

Please will you clarify the points raised? I would rather not leave this topic feeling that your answers were correctly handles, accurate and not in any way ‘evasive’. These responses are visible publicly on the WhatDoTheyKnow website.

Interesting to note that quoted above "A few policies I might mention are the Care Planning Approach policy and Duty of Candour policy but there are many other policies that are likely to refer to carers and families", when the Trust CE has already admitted to breaking those policies in the defence of and cover up of negligence, respectively. How can one believe a single word these people say? I thought I was asking for clarity on specific policy.

The focus here is if (as is evidenced in writing to the Health Services Ombudsman in investigation of Trust negligence) one of the Trust's employees defends their negligence in harassing a vulnerable patient by stating that it was "Policy", apparently to glibly excuse their approach, how can one tell who is lying? Why would the Trust implement such a thoughtless policy - if they did? The PHSO certainly wasn't going to check it, if it made their job easier and they can meet their closure deadline.

I feel the Trust is being deliberately unhelpful and still await clarification.

I'm sorry, I felt your responses could have been clearer with a simple Yes or No in each case, with very little elaboration. For at least 14 years you have promoted working with families to facilitate and improve engagement with patients but now you appear to be saying it isn't Trust Policy.

As I see it, you are also telling me that 3 is your normal number of people attending a mental health Assessment under MH Act., but it could be a lot more if some other unconfirmed policies are applied, irrespective of the detrimental effect on a confused patient potentially vulnerable and without 'capacity' to deal with the intrusion.

I am trying to understand why a consultant would ignore recommended practice for 'engagement' , but simultaneously apply a harmful policy, other than through negligence in consideration of patient's condition? I ask to clarify your policies in this respect.

This simple request has taken too long. The outcome is not clear, and is more confusing.

Please would you deal with this now as a request for an internal review, in the first instance.

Thank you for your request for us to review our attached response received 19/03/2018. I am dealing with this request under the terms of the Freedom of Information Act 2000.

We aim to notify you of the outcome of the review within 20 working days. At this point we will again highlight your rights if you are not content with the outcome or are unhappy with the service you have received.

Further information about your rights is also available from the Information Commissioner at: Information Commissioner's Office Wycliffe House Water Lane Wilmslow Cheshire SK9 5AF Telephone: 08456 30 60 60 or 01625 54 57 45 or www.ico.org.uk

(1) Please can you tell me when the Trust first implemented their policy of involving family or Carers as an important benefit in the management of mental illness?

Answer: A number of embedded policies exist implementing involving family and carers. There are too many to provide evidence in this FOI request and we can not provide any dated current policies, nor specifically, in the context of the time requested. (see 4)

(2) What is the Trust policy on M/H Act Assessment team makeup? (e.g. 2 minimum; 3 recommended; other attendees )?

Answer: Normally 3 in this Trust. Sometimes in addition a specialist may attend. The Trust undertakes assessments as prescribed by Mental Health Act 1983. The Trust can supply no code of practice for the time in question but offers the current one which may or may not differ. It is however based on the same 1983 Act.

(3) Please can you tell me when the Trust implemented a policy of supplementing M/H assessment teams with concurrent attendance of e.g. 'Home Treatment' team?

Answer: There is no policy on this. The Trust cannot provide any evidence to assist the enquirer. (see 4)

Answer: This would be too much effort to clarify under Trust's interpretation of FOI responsibilities. The Trust disposes of historic policies/practices/initiatives/recommendations.

In response I asked the Trust to enquire of relevant clinical 'Leads' in these areas for more clarity. Subsidiary questions arose which I consider could have been covered in a better and more clear response, and I was not satisfied with the avoidable delay and tendency to obfuscation.

Please can you be clear about the context of your response when quoting policy i.e.:

Is it educated/endorsed Trust Policy (capital P), referenced to source material for Trust-wide implementation,
or is it 'policy' as used for instance as a cover-all by a Trust worker to avoid close questioning; meaning what he/she interprets 'on-the-fly'?

Excuse me, I do not understand what your problem is in back-referencing Trust Policy - I would have thought it easily traceable.

1 Attachment

Thank you for your request for us to review our response received
on 19/03/2018

We have carried out our review, which was led by Louise Butler, Head Of
Communications and Marketing and confirm that they were not involved in
the response to the original request. Please find the Trust response
below together with our response to the original request attached.

I have undertaken a review of this FOI request and the original and
subsequent responses by the Trust are upheld.

The reason for this is that we have provided the recorded information we
hold in the form of policies and guidance relating to the requester’s
questions and have in my opinion correctly applied the section 12
exemption to question 4. We sought to provide advice and assistance
following receipt of the initial request by seeking clarification from the
requester on a number of points to enable us to provide an appropriate
response. To provide further advice and assistance we have asked if the
requester can be any more specific about the recorded information he is
requesting in this question. To date we have not received a response but
are happy to consider a more specific request in relation to Trust
policies if that enables us to provide information within the appropriate
cost and time limit.

We have identified that in their email of 11 March, the requester
introduced an additional question within 3 (ii) that was not in the
original request. By way of providing assistance we have asked if the
requester would like us to consider this as new request for information.
We have not had a response as to whether the requester would like this to
be dealt with as a new request but are happy to consider this under the
FOI Act if the requester confirms that he would like us to do so.

Where the requester is asking for information about how policies are
specifically applied in certain circumstances, we are unable to provide
this as these decisions would be undertaken by the team involved at the
time of the assessment dependent upon the situation. The Act covers all
recorded information held by a public authority. The Information
Commissioner’s Office states that: “The Act does not cover information
that is in someone’s head. If a member of the public asks for information,
you only have to provide information you already have in recorded form.
You do not have to create new information or find the answer to a question
from staff who may happen to know it.”

If you are not content with this outcome, you may make a complaint to the
Information Commissioner: Information Commissioner's Office, Wycliffe
House, Water Lane, Wilmslow, Cheshire, SK9 5AF, or visit
[1]www.ico.org.uk

I find it very strange that a body can not supply me with information which must surely have been considered relevant when investigations into negligence and maladministration was involved in the lack of care afforded my son and which led up to his avoidable death. No information was provided before or after the event with regard to then-current Trust policies now apparently lost to history. It was strange also that no mention was made at the time in the Trust S.U.I investigation when the case was fresh, but eight years later admitting concealing evidence.

It appears impossible to differentiate between policies and guidelines and in the event all are up for question in interpretation according to the slant which is desired to put on it. It seems that Policies are such when promoted for 'propaganda' purposes, but in practice they become Guidelines which can be readily ignored by practitioner or so-called investigators (e.g. PHSO) in the event of a complaint.

It is a corrupt system when in enquiries such as this a policy is confirmed as aligning with national best practices when it did not, or does not; and when actions are taken outside best practice, and not Policy at all, a practitioner can just claim "it was policy" and investigators are satisfied: or "No Action Required" in the case of the PHSO.

I'm sorry but this request has been unhelpful, by lacking the clarity requested and, on some points, honesty because you do not follow specific codes to the letter - only interpretations not always made clear at point of delivery, and not documented with reasons for discrimination - as other Policies indicate should be done, according to a previous FOI request.

If Practitioners (and the Trust) can not be clear about what 'Code' 'Policy', or Guideline' they are obliged to follow, how can a patient understand what service and quality of that service to expect. There is a great deal of 'manipulation' of various guidelines when it come to explanations, it seems.

I find it ironic that your FOI reviews check for responding in the 'letter of the law', when the most important final service as an Outcome is Patient Care, aspects of which follow no 'letter of the law' which can be determined or clarified; and if harm is the result, there is no 'duty' or 'law' to be bound to. Incredible, and so wasteful.

Hence my questions, which you did not clarify but threw in more confusion.
You said there was not 'one' policy but there may be a general policy. I am unable to distinguish between policies, codes and guidelines none of which may be mandatory.

Simple Information and clarity was refused. This is showing a pattern.

I will be writing to the Trust with regard to practitioners ignoring established policy designed for patient benefit yet making up 'policy' on-the-fly in disregard to medical situation and causing avoidable harm to patients.

In PHSO investigation, the Trust was asked why so many people (5) had to be present causing threat and a harassment to a vulnerable person:

On 1st Oct 2015 BSMFT NHS Trust responded to the PHSO:

"[We] note that the Mental Health Act was carried out in accordance with Trust Policy. The Law requires that two doctors and an Approved Social Worker were present."

So Trust Policy was first equated with being as per 'The Law', but then they added:

"Trust policy requires that members of the Home Treatment Team need to be present in addition"

suggesting that the Trust had amended the 'law' part with their own policy, hence my question. The 'requirement' or 'need' was never justified.

The Trust were twice asked again by PHSO on a different tack; to which the same reply was given.

Either it was carried out as per 'law' or it was carried out as per a modified policy.
Why was this not consulted-on before its fatal consequence, particularly as they were aware of that consequence beforehand?
It appears that Policy can be whatever they want it to be according to the required outcome.

The Trust have now denied this specifically was not policy and could provide no evidence to this effect.
There appears to be lie here somewhere and it suggests cover-up.